Peng Z, Wang P, Zou J
Second Affiliated Hospital of West China University of Medical Sciences, Chengdu.
Zhonghua Fu Chan Ke Za Zhi. 1995 May;30(5):270-2.
Thirty-three cases with carcinoma of vulva were treated in the division of gynecologic oncology from July, 1989 to April, 1994. Out of 33 cases, 18 with stage II or III underwent radical vulvectomy, pelvic and inguinal lymphadenectomy. These were divided into 3 groups based on the different methods of vulval reconstruction: (1) simple suture group (6 cases); (2) cutaneous flap group (4 cases); (3) myocutaneous flap transposition group (8 cases). The large defect area left by radical vulvectomy and inguinal lymphadenectomy was reconstructed by myocutaneous flap, tensor fascia latae flap, in 6 cases and musculus gracilis myocutaneous flap in 2 cases. All the cases in group 1, 2 suffered from breakdown of wounds, infection or necrosis, resulting in long term hospitalization (mean duration 36.3 days), delayed scar pains, and problems in walking or sexual activity. Primary wound-healing was observed in the 6 cases of group 3, wound infection occurred in one case with diabetes and one case of relapse cancer after radiation therapy. The mean duration of hospitalization in group 3 was 20 days, and neither scar pains nor problems in sexual activity was found after a follow up of 6 months to 4 years. One case in this group died of brain metastases of cancer of vulva. The indications and advantages of myocutaneous flap transposition are discussed. It is suggested that myocutaneous flap transposition surgery is clinically one of the best and safest methods for reconstruction of the vulva and it can improve the quality of life.
1989年7月至1994年4月，妇科肿瘤病房共收治33例外阴癌患者。其中18例Ⅱ期或Ⅲ期患者接受了根治性外阴切除术、盆腔及腹股沟淋巴结清扫术。根据外阴重建方法的不同，将这些患者分为3组：（1）单纯缝合组（6例）；（2）皮瓣组（4例）；（3）肌皮瓣转移组（8例）。根治性外阴切除术及腹股沟淋巴结清扫术后遗留的大面积缺损区域，6例采用阔筋膜张肌肌皮瓣修复，2例采用股薄肌肌皮瓣修复。第1、2组所有患者均出现伤口裂开、感染或坏死，导致住院时间延长（平均36.3天），出现延迟性瘢痕疼痛，行走或性生活存在问题。第3组6例患者一期愈合，1例糖尿病患者及1例放疗后复发癌患者出现伤口感染。第3组患者平均住院时间为20天，随访6个月至4年，未发现瘢痕疼痛及性生活问题。该组1例患者死于外阴癌脑转移。讨论了肌皮瓣转移的适应证及优点。提示肌皮瓣转移手术是临床上重建外阴的最佳、最安全的方法之一，可提高生活质量。
